RESUMO
UNLABELLED: One problem of vascular angiogenesis therapy is the lack of reliable methods for evaluating blood flow in the microcirculation. We aimed to assess whether (99m)Tc-macroaggregated albumin perfusion scintigraphy ((99m)Tc-MAA) predicts quantitated blood flow after therapeutic angiogenesis in patients with peripheral artery disease. METHODS: Forty-six patients with peripheral artery disease were treated with bone marrow mononuclear cell implantation (BMCI). Before and 4 wk after BMCI, blood flow was evaluated via transcutaneous oxygen tension (TcPO2), ankle-brachial index, intravenous (99m)Tc-tetrofosmin perfusion scintigraphy ((99m)Tc-TF), and intraaortic (99m)Tc-MAA. RESULTS: Four weeks after BMCI, TcPO2 improved significantly (20.4 ± 14.4 to 36.0 ± 20.0 mm Hg, P < 0.01), but ankle-brachial index did not (0.65 ± 0.30 to 0.76 ± 0.24, P = 0.07). Improvement in (99m)Tc-TF count (0.60 ± 0.23 to 0.77 ± 0.29 count ratio/pixel, P < 0.01) and (99m)Tc-MAA count (5.21 ± 3.56 to 10.33 ± 7.18 count ratio/pixel, P = 0.02) was observed in the foot region but not the lower limb region, using both methods. When these data were normalized by subtracting the pixel count of the untreated side, the improvements in (99m)Tc-TF count (-0.04 ± 0.26 to 0.08 ± 0.32 count ratio/pixel, P = 0.04) and (99m)Tc-MAA count (1.49 ± 3.64 to 5.59 ± 4.84 count ratio/pixel, P = 0.03) in the foot remained significant. (99m)Tc-MAA indicated that the newly developed arteries were approximately 25 µm in diameter. CONCLUSION: BMCI induced angiogenesis in the foot, which was detected using (99m)Tc-TF and (99m)Tc-MAA. (99m)Tc-MAA is a useful method to quantitate blood flow, estimate vascular size, and evaluate flow distribution after therapeutic angiogenesis.
Assuntos
Transplante de Medula Óssea/métodos , Neovascularização Fisiológica , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Compostos Radiofarmacêuticos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Idoso , Índice Tornozelo-Braço , Artérias/diagnóstico por imagem , Artérias/crescimento & desenvolvimento , Arteriosclerose Obliterante/diagnóstico por imagem , Arteriosclerose Obliterante/terapia , Feminino , Pé/diagnóstico por imagem , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Compostos Organofosforados , Compostos de Organotecnécio , Oxigênio/sangue , Dor/etiologia , Medição da Dor , Doença Arterial Periférica/complicações , Tomografia por Emissão de Pósitrons , Fluxo Sanguíneo Regional , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/terapia , Resultado do TratamentoRESUMO
The outcomes of 60 patients aged > or = 90 years with hip fractures who underwent surgery between 1995 and 1998 were reviewed. Average follow-up was 21 months (range: 4-47 months). All patients experienced pain relief within 2 months postoperatively. Thirty-four of 60 patients failed to attain their preinjury ambulatory status. The ability to walk 2 months postoperatively was observed more frequently in patients without severe dementia. Patients who were unable to walk postoperatively had a greater chance of dying than those who regained the ability to walk. No surgery related deaths occurred. Six months postoperatively, 2 (3%) patients had died; 1 year postoperatively, 9 (15%) had died. Therefore, patients aged > or = 90 years benefit from surgical treatment of hip fractures.